Long-Term Mortality After Hurricane-Related Flooding Among Skilled Nursing Facility Residents With Dementia

Examine the association between dementia and all-cause 5-year mortality among skilled nursing facility (SNF) residents exposed to Hurricane Sandy flooding.

This study analyzed Medicare fee-for-service (FFS) beneficiaries aged ≥65 receiving care in SNFs located in flooded ZIP codes in New York, New Jersey, and Connecticut (October 2012). A 20% Medicare FFS sample was linked to Minimum Data Set assessments, LTCFocus, Care Compare, and American Community Survey data. Flooding exposure was defined using 2012 U.S. Geological Survey flood shapefiles. Follow-up extended 5 years. Analysis included Kaplan-Meier curves, multivariable Cox models, and propensity-score matching.

Of 1,627 SNF residents, 767 (47%) had dementia. Compared with those without dementia, they were older (≥85y: 52% vs 38%; P < 0.001), less often non-Hispanic White (67% vs 75%; P < 0.001), and more frequently dually eligible for Medicare/Medicaid (63% vs 40%; P < 0.001); Charlson comorbidity burden was similar (mean 4.9; P = 0.95.). Dementia was associated with higher 5-year mortality after full adjustment (HR 1.20, 95% CI 1.05-1.37), and propensity-score matching (HR 1.24, 95% CI 1.08-1.44). Median survival was 1.68 years vs 2.61 years.

SNF residents with dementia in flooded areas had higher 5-year mortality, underscoring the need for dementia-specific disaster plans.